Sunday, February 18, 2007

God of the Appendix: Of Truth And Worms

Of Design and Darwin, the appendix speaks to me. With my finger through a hole in the abdominal wall, I sense it, and at two in the morning it tells the truth.

In the appendix, we have a thing within us of no demonstrable value, but which is capable of doing us great harm. People may argue at the edges, but there are two things we know with central certainty: the presence of the appendix kills a lot of people or makes them real sick, and its absence is of absolutely no consequence. Evidently, that's a threat to the concept of intelligent design/creationism, and in a sort of endearingly weak effort, Ken Ham, a major ID guru, once tried to explain it away. Believe it away. Faith it away.

If you take a position in matters of science, says I, you need to keep at least one hand on the fact wall at all times; otherwise, you fall down. So whereas I'm not the first to address the appendix as religious icon, I'm only aware of a couple of people talking about it who've held a thousand or so in their hands. That's concrete: I assert my credibility. (The article to which I linked above has a reference to an article by a surgeon. It's from the same website, "Answers in Genesis," and is impaction-full of the same sort of pseudoscientific assertions. The author is an evolution denier and a creationist.) In the human body there's no other structure of any importance that feels and looks like a silly noodle, and which varies in people from a little stub to several inches long. (I hear one of you thinking something, and you should be ashamed of yourself.) I've removed a bunch of 'em, and I (nor anyone else) have never seen an adverse consequence of appendiceal non-existence. But I've seen a hell of a lot of carnage from appendicitis.

Here are examples of the arguments about appendicoloid importance in the article I cited.

"Today, the appendix is recognized as a highly specialized organ with a rich blood supply. This is not what we would expect from a degenerate, useless structure."

Highly specialized? As defined how? Recognized by whom? He offers as proof of the appendix's function, a statement that the appendix has function; lacking are any actual studies. And it hardly has a rich blood supply. It does have blood, alright: it's alive. But rich? The stomach has a rich blood supply: it's fed by several arteries, coming at it from all directions. You can hardly kill the thing. The appendix? A single artery, the bare minimum, I'd say.

"The appendix contains a high concentration of lymphoid follicles. These are highly specialized structures which are a part of the immune system. The clue to the appendix’s function is found in its strategic position right where the small bowel meets the large bowel or colon. The colon is loaded with bacteria which are useful there, but which must be kept away from other areas such as the small bowel and the bloodstream."

Like most of the intestinal tract, the appendix has lymphoid tissue. Which in and of itself proves nothing. Take out the appendiceal lymph tissue, it might cover the nail of your pinkie. From the rest of the GI tract, you could haul it away in a bucket. Nor is its location a "clue," absent any data to support the assertion. Mr. Ham shovels us an implication that the appendix has something to do with keeping bugs out of the bloodstream: a statement only, with no proof, no studies. A theory perhaps? To the contrary: take out an appendix and poof: no bugs in the bloodstream. Appendicitis, on the other hand, seeds the bloodstream with bugs in many a victim. Bacteria in the small bowel? Plenty of 'em, especially right next to the appendix. He implies the appendix keeps them out. It's simply silly to say such things.

"Through the cells in these lymphoid follicles, and the antibodies they make, the appendix is ‘involved in the control of which essential bacteria come to reside in the caecum and colon in neonatal life’. Like the very important thymus gland in our chest, it is likely that the appendix plays its major role in early childhood. It is also probably involved in helping the body recognize early in life that certain foodstuffs, bacterially derived substances, and even some of the body’s own gut enzymes, need to be tolerated and not seen as ‘foreign’ substances needing attack."

The quote within the quote is from the surgeon's treatise, on the same website -- so in effect, the article quotes itself. Again, an assertion, made up out of whole cloth. Not a demonstration, not an even an attempt. Why? No evidence. Couple of scientific words. He goes on to say the appendix is "probably" like the thymus. Probably? How so? PROBABLY?? What kind of science is that? We know a great deal about the thymus' function in early life. Removal in infancy has significant consequences, demonstrably. Removal of the appendix in infancy has none that have ever been shown. In fact, it's in infancy that the appendix is most deadly: because appendicitis is harder to diagnose in a babe, rupture before discovery is more common at that age than in older people. If I'd had a magic way to remove it from my newborn son, I'd have done it. But here's the best stuff:

"But if it has a function, why can it be removed without ill effects?

Our body has been brilliantly designed, with plenty in reserve, and the ability for some organs to take over the function of others. Thus there are a number of organs which everybody agrees have a definite function, but we can still cope without them. Some examples:

*Your gall bladder has a definite function—it stores bile from the liver, and squirts it into the intestine as required to help with the digestion of fat. However, it can be removed and the body will cope—for instance, by secreting more bile continuously.*You can cope with having a kidney out, because there is still enough kidney tissue left in the other one. (In the same way, a part of the Gut Associated Lymphoid Tissue, which includes the appendix, can be removed, and the remaining lymphoid tissue will usually be enough to carry on the total function). You won’t suffer from having your thymus out (if you’re an adult), because this extremely important gland, which ‘educates’ your immune cells when you are very young, is then no longer required. This is likely to be very relevant to the appendix."

Yipes. Except for the appendix, there's no organ out with which we can do without some chance of problems. Removing the gallbladder, while tolerated by most people, is associated with known and specific problems in a number of patients. It even has a name: post-cholecystectomy syndrome. He might have mentioned the spleen: you can live without it. But there are known risks: increased chance of blood clots, and increased susceptibility to certain life-threatening infections. Without flim-flam, we know the exact functions of these organs. The kidney analogy is so self-evidently stupid as to require no comment at all. And the "likely to be very relevant to the appendix" statement pretty much speaks for itself: another assertion ex cathedra. Because the appendix threatens his world-view, he's making stuff up: no function has ever been demonstrated, and no adverse consequence of its absence has ever been shown. There's no other organ about which it can be said. Face it, guys: the appendix is useless. (I mean it no offense. After all, it's put bread on my table.) That's just what the facts are: the sun rises in the East, and the appendix is useless. Assimilate it.

The study I cited most often to my patients when asked about adverse consequences of appendectomy is one done by the Mayo Clinic: they studied records of thousands of patients who'd had appendectomy, and compared them with equal thousands who hadn't. (Back in the day, it was very common during any abdominal operation to remove the appendix. Like flicking a bug off your shoulder. No extra charge: just did it to prevent further problems: took an extra couple of minutes, is all.) The groups were statistically similar in every way other than presence of the worm. There were no differences in incidence of any disease. It's as convincing as it gets, given the impossibility of doing a prospective double-blind study.

That the appendix has no unique or physiologically important function is as certain as it can be, based on what we can easily observe. I know it from direct observation, from operating countless times. Maybe if it weren't for us surgeons saving fertile people from their vermiformera, the little rascals would be gone by now. But the existence of a vestigial organ which, when it does anything at all, only does harm, is a threat to certain narrow religious views. Vestigial bespeaks evolution, so let's make something up. I find that interesting. And I find the attempts to will it away amusing. If you don't like certain facts, make up some new ones. If the facts don't fit your faith, change the facts. That sort of thinking has been known to start wars. And it gives faith a bad name.

By its existence, the lowly and useless appendix would seem to deal a fatal blow to the idea (at least Ken Ham's version) of Intelligent Design. Slain, by that ignoble worm, that surgeons'sidekick, my midnight mistress. If you deny evolution, then you have to say the designer wasn't paying attention, says the appendix to my scalpel; or the designer acted deliberately to stick within us something which serves only to harm. Even more scary. Unless, of course, you're a general surgeon.

Addendum: a study in Sweden found an increase in Crohn's disease after appendectomy (we're talking very small numbers here). What's not clear is whether we're seeing chicken or egg: ie, is it that people who will develop Crohn's are more susceptible to appendicitis, or does appendectomy somehow increase susceptibility to Crohns? Interestingly, appendectomy has been associated with a lower incidence of ulcerative colitis. And appendectomy before age ten, in this study, seemed to have no impact at all. To me, that suggests that the Crohn's link, if real, is indeed that Crohn's disposition is causing the appendicitis in that small subset of people. In other words, as you get more toward the age when Crohn's occurs, you'll see more of the connection. If appendectomy caused Crohn's, you'd expect the effect to show in the young kids as they grew up. Or at least I would.

[Update, 8/09]: In another (and quite unrelated) thread I've been asked about this study, which argues that the appendix could function as a sort of storehouse to replenish bacteria in the gut. In fact, it's an interesting speculation, but is no more than that. Also, it states that appendicitis is due to defect of some sort in the immune system -- made with no data to confirm. The study makes plausible extrapolations from the evidence that the appendix has evolved at least twice in certain animal lines. To leap from that to the idea that there must be a function in humans, and to propose without evidence what that function might be is hardly dispositive. The fact remains that in many studies of the appendectomized among us, no real evidence has emerged of a negative impact. Not at a rate that is very suggestive. And the paragraph above this suggests if there are effects, they about cancel each other out. Given the numbers of appendectomies done around the world, it's logical to think something would have shown by now. Nor does the study in this paragraph give credence in ANY way to the out-of-the-orifice statements of Ken Ham.]

47 comments:

Two reasons for no more "incidental appendectomies" (which is what removing a normal appendix as part of another abdominal operation is now called):

1. A higher rate of complications. Even an appendectomy is not without potential complications, and it would not do to have a complication from what is, in essence, an unnecessary operation while doing something else.

2. Informed consent. You can't do what you haven't gotten consent for.

Nowadays, for the most part, the only time we do incidental appendectomies is if we put an incision on the right lower quadrant that looks like an appendectomy incision. That way there is no chance of missing a case of appendicitis "because the patient has an appy scar and must have had an appendectomy" should the patient develop fever and right lower quadrant pain in the future. We also sometimes (although rarely, these days) do it in immunocompromised patients who are undergoing an abdominal operation and for whom appendicitis would be particularly devastating.

I believe that you need to be careful not to talk up appendectomy too much. Obviously, if it is indicated, the procedure should be performed, but it definitely shouldn't be performed "just in case".

My father carried out an epidemiological study some years ago (in the 1970s) on the survivability of appendectomies in West Germany vs. other germanophone countries, as well as the US and the UK (iirc). What he discovered was that West Germany had something like 10x the mortality rate (per-capita) due to appendectomies that the US had. As it turned out, this was because West German surgeons had a "cut first, ask questions later" philosophy regarding abdominal pain.

The point was, it's better to perform no operation than to perform an unnecessary one.

Incidentally, it may be worthwhile noting that a significant number of people who died due to their appendectomy had their deaths labeled as something unrelated, as they may have occurred some time (a week or more) after their operation. These deaths would not have been counted in the mentioned studies.

I believe (but I'm not quite sure) that said study is presented in the papers that are identified in the PubMed index as 820981 and 5562429 (although there may be others, too).

An association between Crohn’s and appendectomy makes perfect sense- Crohn’s (AKA terminal ileitis) causes RLQ pain and is/was an indication for appendectomy, at least in the days before the registration clerk ordered the abd/pelvis CT with double contrast for every bellyache that came into the ER. Folks may have come with pain from undiagnosed Crohn’s and had their wormectomy. I have made initial diagnoses of Crohn’s during appendectomies in the past and I’m sure you did too. If the study reported an association between Crohn’s and appendicitis (not appendectomy), then we have some splainin’ to do.

I don’t claim to have a complete understanding of ID/creationism/Genesis vs. Darwinism/evolution, but I do admit to a great deal of skepticism over the concept that human life, or for that matter mitochondrial function, developed as a result of random biological variation acted on by natural selection. Knowing something about how the human eye works, how complex the human digestive, renal, cardiovascular, or any other system is in its basic function, not to mention the nervous system and intelligence, makes me extremely skeptical that all of this occurred more or less by accident. Evolution is all around us- evident every time we consult an antibiogram- but for me it's too much of a leap from there to the ability to focus and adapt automatically to light levels, or maintain serum calcium and potassium within a tight range. I suspect that there is something else entirely that allowed us to become what we are, and that we are currently totally clueless about what it is. This might be analogous to expecting Isaac Newton to be able to explain relativity (moving clocks run slow and all that) when it was true genius for him to describe his laws of motion based on his own observations. A stretched analogy, to be sure, but there has to be something else out there- even with a near infinite number of chances, we are more than a collection of random events.

all that is well and good, but what about this long fluffy vestigal tail of mine? it's embarrassing me at church!

That's a common and evenly solved situation. After going number 2, tear off as much toilet paper as you use, rather than leaving it attached to the roll. After using it, drop it in the toilet before flushing. Result--no long fluffy tail!

Be careful sweet surgeon. Never forget who the first surgeon was. First transplant ever, was the rib.All other unexplainables are the mysteries of the first surgeon, not to be known until the student is ready. You had to know this would bring me out.

As usual, I'm not finding arguments from ignorance and incredulity convincing. JB, if you don't know evolutionary biology, then of course you don't know how the mechanisms you cite evolved. I'm not a biologist, I don't know the details, and I know I don't know the details. I can't claim something's wrong just because I don't understand it.

"There has to be something else out there".. what something else? Why? The real world, the universe in all its splendour, isn't good enough for you, so you have to imagine "something else"?

Chrysalis Angel, perhaps you think you're being deep when you talk about "mysteries [...] not to be known until the student is ready", but that's just trite. Even if your God exists, you don't have some magical link hooking you into profound secrets. Your "first surgeon" hasn't seen fit to write a text and he sure doesn't seem to be taking new patients. In the absence of miracles, the hard work of science is our best bet.

Chrysalis Angel is being rather oblique about something, but my best guess is that it's the same old "unbelievers don't know!" for which Ham and Wieland quote Corinthians. They warn us that "if any man think that he knoweth any thing, he knoweth nothing yet as he ought to know." However, this never seems to apply to the believers themselves! They claim that scientists, who actually work for knowledge, know nothing, while they're perfectly content to make up any interpretation of Scripture they like and claim that it is utterly infallible. Even if, as in the case of creationism, it is at odds with observation of the real world, it must be the world that is wrong, not their divine nonsense.

Where were Ham and Wieland when the Earth was created? Where were they when the appendix evolved? If they don't have proof that the appendix was designed by God to serve a specific purpose - that is, probably to serve it, I guess - then perhaps they should think about those questions before making up stories.

I've never visited before, I was linked to this post via Pharyngula. This was a very clever and funny article. Way to rock good science and lay the smack down on creationists.

As for Chrysalis Angel: I have no idea who you are...or what your prior interactions with this blog's author have been, but after following the link to your blog to make sure you weren't kidding I must say that you are clearly a moron. I know you didn't actually read his post, or if you did you had your theist auto-censoring on and you missed all the logical and intellegent points he made. Your inane, vaguely condescending comment is useless and you should stay out of serious scientific discussion if all you're going to do is spout religious one liners like "the first surgeon."

Apologies to the author if you feel my response was inappropriate...I just really liked your post and I can't stand crap like that from theists.

See, now I have to wonder... I could have sworn reading a few years back that there was some thought about a lymphatic function of the appendix, but I honestly can't remember where... Now I'm crushed to know a small "fingernail's width" of cells was leading up to my belief...

Now, about the uvula... I had mine removed during sleep apnea surgery some years back, and the surgeon said it too had a lymphatic function, but "just like the appendix" it wasn't something my body would miss.. Now I have to worry about that, too!

ut if you read what Martin says, basically all he’s got is (a) the appendix has immune system cells, and (b) surgeons can use it as a spare part in a particular surgery.

(b) is rare and only useful in the last decade or so. (a), on the other hand – how do we know the immune system cells aren’t there simply because all gut tissue has it, or to forestall the fatal infections which still occur anyway at a significant rate – according to this article:

A life table model suggests that the lifetime risk of appendicitis is 8.6% for males and 6.7% for females

There darn well better be immune cells in the appendix with this sort of thing being a regular occurence in the population. But this is a long ways from showing the appendix has a function; rather, we might just be seeing evolution try to make the best of a bad situation.

I would be interested in Surgeonsblog's comments on the What the creationists typically quote is this 1999 interview at Scientific American with "Loren G. Martin, professor of physiology at Oklahoma State University":

ut if you read what Martin says, basically all he’s got is (a) the appendix has immune system cells, and (b) surgeons can use it as a spare part in a particular surgery.

(b) is rare and only useful in the last decade or so. (a), on the other hand – how do we know the immune system cells aren’t there simply because all gut tissue has it, or to forestall the fatal infections which still occur anyway at a significant rate – according to this article:

A life table model suggests that the lifetime risk of appendicitis is 8.6% for males and 6.7% for females

There darn well better be immune cells in the appendix with this sort of thing being a regular occurence in the population. But this is a long ways from showing the appendix has a function; rather, we might just be seeing evolution try to make the best of a bad situation.

I read a lot of blogs but have never commented on one. This morning I woke up very early and couldn't decide whether to get up or try to go back to sleep. I immediately thought of your blog and wondered what you might have written today and of course decided to get up and see! I have told many family and friends about your blog because I find your ability to make medical subjects so understandable for the average patient. I am also awed by your reverence for the human body and hope that if I should need a surgeon that he thinks like you do.

My husband writes a blog - Hall of Record - that lately has been about global warming. I am always amazed that someone would literally write what can only be called "term papers" without being made to!

I am very glad that there are people like you and my husband who really think about subjects and are willing to share it with others.

At the risk of sounding trite, inane, condenscending, moronic, or mysterious, I offer the following in regards to the purpose of the appendical worm.

Could it simply be the case that God has a sense of humour?

I cannot help but imagine him belly laughing as he watches us mortals puzzle out this riddle.

Can it be as simple as a "gotcha" found in the treasure chest of holy grail fame?

And why do all dialogs of this sort revert to name calling and personal attacks? For either side of the issue, an argument loses its ability to persuade when part of the logic includes derogatory language, at least in my opinion.

You guys are pushing my buttons, as a comparative physiologist and long-time teacher of same and introductory biology to aspiring pre-meds...Surely the human body is a remarkable and complex mechanism. Yet nothing is really different physiologically from fish, frogs, sharks, or newts (except brain size and visceral endothermy). At the cellular level Paramecium is more complex, and amoebas too. Mitochondria? They trace back--directly, by descent--at least 1.5 billion years and probably 2, and then back further than that in the alpha-proteobacterial ancestors of the original mitochondrial endosymbiont.As the Rolling Stones say, time is on our side.

I think everybody's had that thought at one time or another, but of course that wouldn't really make for a good sermon.

Another anatomical puzzler for the Design camp is the curious backwards arrangement of the retina in vertebrates. The rods and cones are all wrong-way-round, with the optical nerve coming out the same side of the retina that the light strikes, then running back to the brain through a tiny hole off the center of the retina (that's why you have a blind spot).

Interestingly, squid & octopus have eyes that are in basically the same arrangement as ours (lens, iris, retina) but their rods and cones are constructed more logically, with the nerves in the back and no blind spot.

So you've got two different layouts, both present in nature, one clearly more sensible than the other, and humans get stuck with the bad one. That's Intelligent Design sunk, although I suppose there's still hope for the theory of Clumsy But Well-Intentioned Design, or Design by Committee, or Insane and/or Stoned Design. Or maybe God just loves octopuses more than he loves people. I know I feel that way sometimes.

Damn, I knew I shouldn't have put up this post while on vacation, with limited internet access (I'm cramped in my car at the moment, stealing wi-fi from my favorite coffee-shop/bakery at the Oregon Coast... Not stealing, really; they've said it was OK, since I'm a would-be regular....)

I'm proud to say the comments here are at least marginally more respectful than those on some other sites that referred to this post. Some people, it would seem, feel that any opinion by a surgeon is invalid since, well, you know.... Us surgeons are just hands without heads....

I stand by my post: in fact the criticisms brought up have been addressed within it: yes there's lymphoid tissue in an appendix, as there is in the entire GI tract. I'm embarrassed to say I have hairs on the end of my nose. I pluck 'em.

And the only credible study (meaning ones unlike the Ham-handed one) that showed any adverse effect of removal, which was tiny, I addressed at the end. Effect and cause, not cause and effect, I'd say.

Why is "incidental" appendectomy no longer done? That's an excellent question: I grew up doing them, and evolved along with everyone else toward not..... In the days of big incisions for gallbladder removal, we'd very often flip the worm into the wound and excise it. In my case, as I developed smaller and smaller incisions (as described recently), it was no longer easy or possible. And, as has been said, there is always a very slight risk of infection when opening the GI tract in an otherwise "clean" case. In the olden times, I don't recall ever seeing an infection due to incidental appy, but I do remember thinking it a risk in some cases. I continued to do it when the appendix was "in the way." When the incision (or the disease) was, as Orac said, in a place where developing appendicitis in the future might make for a confusing situation, diagnostically. I know several gyn docs who still do it pretty often.

The absense of identified function seems pretty clear: we know what everything else does. I realize ignorance isn't proof: yet if it had a function, I think it's pretty clear we'd know it. Gazillions have been removed. The study I cited at the end, which raised Crohn's is questionable for the reason that I (and JB) mentioned. I didn't mention that the same study also raised a slight but not significant PROTECTIVE effect of appendectomy vis a vis ulcerative colitis. And the fact that removal before age 10 had no effect at all is, as my brother the attorney would say, "despositive."

To you specifically, chrysallis angel: I've removed a couple of comments over the past months that were insulting to other commenters. I apologize to you for the nasty ones here, but I left them in. I hope you don't mind. I've enjoyed all your previous comments and hope you'll keep coming around. I welcome all points of view; as long as they don't get too nasty to me personally. I figured this post would bring a broad spectrum of responses, and so far anyway think they are alll interesting, for many reasons. So I didn't delete your attackers. You may have noticed I haven't stated personal views. Not yet anyway. Faith isn't excluded by the appendix, just some flavors of it. We don't have data on Adam's rib, so at this point I remain silent. We do have data on the appendix, and it puts the lie to Ken Ham's view. Is all.

Thanks for the links to Answers in Genesis. That website is always a hoot. It is so silly its sometimes difficult to determine if it's a parody or not. Of course it is good to see someone with credibility tear them to shreds.

Orac, they do still do appy routinely with major ab surg. As far as consent goes, you sign a blanket form saying you are agree to have xyz removed, plus the appy, plus anything else that looks funky or uncool.

You are missing the point that the intelligent design folks are making. The point is not that the human body is perfect - that is manifestly absurd.

I don't think even the most backward, toothless, snake-handling fundamentalist believes that.

Intelligent design is a critique of current evolutionary theory. Sure they go too far by equating holes in evolutionary theory with evidence for "design". But, it would be an equally grievous mistake to ignore their arguments for that reason or to paint them in with the "bible says the world is 6000 years old" crowd.

If you want to pick a fight with intelligent design, pick on a William Dembski or a Michael Behe and attack their main points, don't play gotcha with some trivial peripheral issue.

I know it's fun to pick on the dumb kids, as you did in your article. But, at some point doesn't that get old?

Well, with Chrysalis Angel's followup I'm still not sure what the initial post was supposed to mean, though it still looks condescending to medicine to me. Angel, I look forward to it should you deign to converse with this mortal as an equal, rather than condescending to me as a nuisance.

Even during a short time in my childhood when I went through the motions at a church, I never really saw the point of faith, but my intent in this thread isn't to challenge religion. (I might succumb to temptation, but it's not the aim.) What really brings out the "nasty attacking" in me are those creationist obfuscators who reject reason, which they ought to regard as a gift from God, and then set out deliberately to deceive others about the facts to make them reach certain desired conclusions. Thanks, Dr. Schwab, for calling them to task for their misrepresentations of medicine.

Re: JB's remarks, I respect his expertise and wouldn't challenge the medical part. With my lack of medical knowledge, I fear my comments may prove pointless by comparison to what we're reading here about the appendix, but oh well.

I don't know what you mean by "any opinion by a surgeon is invalid," but in case that's about me I'll say that JB's certainly as entitled to have vague feelings about the mysteries of life as anyone. However, I fear that giving too much credence to such feelings can lead one astray. My day job's math, and even in that narrow field my hunches are sometimes right but often wrong. His ideas sound to me much like the "irreducible complexity" notions of ID, and his example of the eye is a familiar one which has been considered for a couple centuries at least. Yet, despite the efforts of such organizations as the Discovery Institute, ID has failed to produce significant suppoting research, much less scientific acceptance. It's an interesting line of introspection, but one that is well known to biologists who nonetheless accept evolution.

The analogy to Newtonian mechanics and relativity doesn't convince me. Newton failed to notice moving clocks running slowly because the effect is far too subtle at everyday speeds and I doubt he had the electromagnetic theory at that time to lead to considering whether the speed of light ought to be measured as constant by all observers. On the other hand, the biological mechanisms to which JB refers are observed, studied, and now well known. If they really did refute evolution and require a new theory, why isn't such a theory changing biology as we speak?

I don't exactly want to attack the participants here, but do believe that ideas ought to be tested. If I'm wrong, by all means, let me know. And if I've set up a strawman by misrepresenting someone's opinions, again, call me on it. Yet, if I find someone else's argument unsatisfactory, I'll remark. If I'm wrong, hopefully I'll learn something.

wrg, I don't have a condescending spirit. Those that have gotten to know me a little, know I am gentle and sensitive. Hurting someone is most definitely not the way we learn from one another. I agree that Ken Ham should not "make up" something, when he does not know either. We have to say...we don't know. Faith and religion are two different things. Many a misguided church have done things in the name of religion and have been very wrong, and given true followers of Christ a very bad image. Perhaps you would find some interest in the work of John Bayes. I would assume you are familiar with it, The Bayesian Inference might be of interest to revisit, or not. I'm saddened this all happened. It would have been nice to receive an apologie, but I'll take the less hostile tone. No need to further go on with this all, poor Sid. I won't be returning, so you can feel free to discuss Science.

Seems some research in the area of the Bayesian Inference supports your end of things. I'm not up to date obviously, I have had more pressing issues to attend to, so my apoligies for being wrong on the reference. It doesn't mean however, they are correct. Some things you have to know in your heart. Somethings you have to take on faith. I have had experiences you can not know. I am certain of my belief. I leave you to yours with respect given you. I'd like the same please. I wish you the best.

I know what the appendix is for! It's where your soul is kept. Remove it, and you lose your soul. The soul is indetectable by modern science, so of course you're skeptical. But it all makes sense. Let me explain:

We learned in book three that people and live perfectly well without a soul. Well, it's not really you anymore, but the body lives on. But you'd hardly notice that! Well, the new you woudn't notice. And your friends wouldn't notice either. You'd just go about doing things mechanically, like you'd always done them. The new you, which isn't you at all.

So, the surgeon removes it. But the anesthetic is pleasant. You go to sleep. The new you wakes. That's much nicer than a dementor's kiss, to be sure.

Dr Schwab,We had almost the same discussion in my internet college Intro. to Biology course last Fall. The subject was Darwinism and the class was asked to post and reply to the various opinions, however to keep the discussion civil. I thought the discussions were a little too civil - passionless - and I always wondered if that in itself didn't frustrate the instructor. I gave the class a link to your blog but I wish that somehow you could have popped into our discussion and livened it up a bit - I think these different opinions and the passion from which they were conceived are to be celebrated. I think that both creationalism and Darwinism are correct with a broadened mind.

Anonymous 8:37 pm: I know about the appendix. I've held many, as I said, in my hand. I write, as they say, what I know. Behe and Dembski have been more than ably and totally taken apart, by evolution experts (including, as I'd guess you know, in a court of law.) If you really want to see how it's done, go to Pharyngula and search his blog for the real deal. It'll open your eyes.

"... yet if it had a function, I think it's pretty clear we'd know it."

Evolution dictates that someting is going on. Were it not for modern medicine and surgery, on the order of 0.5% of people would die of appendicitis before the birth of their second child. A purely detrimental trait like that would be extinguished within a few thousand generations. (Do the math. A relative survival rate of 0.995 raised to the 5000th power is a pretty tiny number.)

Appendicitis susceptibility's continued existence means that it must be either an unavoidable side effect of a strongly-conserved trait*, that it is due to recent environmental changes**, or that the appendix is hard to select away without breaking lots of other stuff.

*It certainly seems to lack a digestive function, but I bet nobody has checked whether it preserves symbiotes during diarrhea. Or for that matter actively selects less-pathogenic commensal microbes.

**E.g., switch to agricultural diet, eradication of intestinal worms, changes in vitamin D-derived hormone levels, ... There are many possibilities.

1) Dembski made a mistake checking google stats on ID searches. This was then followed by a claim about the google search graph that didn't quite fit the data - certainly not decisively. (that was on a linked page to be fair).

2) Derogatory references to statements claimed to be made on the "overwhelming evidence" web-site. I couldn't find these types of statements on the site, nor could I find any reference to Dembski being behind the site as they allege.

3) Various hyperbole (which can be fun sometimes) about some IDer's not being biologists, etc. None of this was directed at the core ID arguments with current evolutionary science.

4) A complaint about Ann Coulter using hyperbole and invective. If you have read their other posts, I don't need to point out the irony here.

Nowhere could I find any dealing with "meaty" issues. Intellectual vegetarian, maybe?

Say! is there a "missing link?" in other words, any analogous useful organ in other animals to suggest what the appendix might have evolved from? An archaeopteryx-appendix analog, somehow. I'm no comparative biologist but it'd be fun to look for if I were.

Also, I can't resist putting in my NSHO about science and religion: Science asks "how?" Religion asks "why?" At least that's how it should be! I know some scientists are annoyed that anyone even wants to ask "why?" I say, "why not ask why?"

You know, some people need to believe in a creator, in order for them to feel like the bad stuff that has happened to them has happened for a reason, or that bad people who have good stuff happen to them will eventually get what's coming to them. Life would be pretty hard for some people to come to terms with without these assurances.

Of course, life doesn't care whether you come to terms with it or not. I don't understand why we can't just be OK with having church in church and science in school. I mean, cognitive dissonance is an important part of the human psyche, right? So let's dispense with these terrible statistical arguments about irreducible complexity and just get along believing what ever makes us happy to believe, and let other people believe whatever makes them happy to believe, without one side trying to force their beliefs on the other. Some people aren't looking for reason, and they shouldn't have it forced upon them, should they? All they have to do is give up is the right to make decisions that affect other people who don't share their particular vision.

Here I sit, finally able to sit long enough to read some of this website and, type a comments or two, after having emergency surgery recently. There was only a suspicion of what was causing my pain... even after the xrays, ultrasound and CATscan - making it necessary to leave about a 12" vertical scar on my abdomen. The recent surgeon had to 'explore'. Rightfully so... I was told the risks, approximate size of the scar but of course, with tears streaming down my face, I nodded and agreed. It was the worst experience I have had yet... After my experience, rather, ordeal of recent surgery, I must say, I agree that the appendix seems to cause more damage to people than anything else... All because of one little piece of my appendix that was left behind from a common procedure, that latched onto the backside of my bowel and ruptured... I'm left now with a thought, do I just chalk it up to we are all just 'people' and making mistakes is only human? OR, should we as people expect the educated surgeons who's life choice it is to FIX the human body, to be perfect? I am not a malicious person... rather, I feel extremely thankful to the surgeon 17 years ago, who alleviated my pain in the first place while at the same time causing me tremendous pain later... and, especially to the more recent surgeon who fixed the leftovers... Perhaps count my blessings and just move on? Perhaps I should complain to the COS...? Ouch... I can't sit anymore... it's too uncomfortable... wait a minute, it hurts too much right now to lay down too... perhaps I will just stand for a few minutes...

Topic :-Vestigial organs not necessarily proof of evolution for Darwin

I would postulate that it is possible to have a vestigial organ [ananatomical structure in organisms in a species, thought to have lost its original function through evolution] without the process of evolution. Let me illustrate this idea using an analogy drawn from popular computer software.

Assuming, I have a reasonable amount of storage space on my computer hard disk, if I first create an unformatted document using Microsoft(MS) Word, and then a second MS Word document that I format very rigorously, I do so because I consider MS Word software to be the best option for my purposes, as opposed to using, say, the less sophisticated Notepad software, where little formatting of documentsis possible.

Now, if you argue that there is a vestigial structure to the first MSWord document (the capacity - in this case, unused - for formatting)and that this only became functional in the second document,ultimately concluding that the first document evolved from the second document, you would be incorrect, since I am the creator of both documents.

Similarly, I would argue that vestigial organs do not necessarily confirm evolution; they only point to what tools - improvable overtime - the creator used while making the species. This same principle is seen even in electronic gadgets today.

Most probably, such an explanation did not occur to Darwin given that, in his time, there were no common tools to carry out varied, complex,seemingly disconnected jobs. So he concluded that unless a creator planned to mislead us, vestigial organs should not have existed

It is tendency of creators of to make some useful common tools, which can be used to carry out multiple jobs (or to make machines). so by virtue of this comman tools (if tools get fitted into machines), vestigenesity will come up.

Vestigial organs can be classified in to verticle & tranverse ones

Verticle ones are like appendix which are inherited from ancestor to next species

Tranverse one are in which one sex has fuctional capacity & in opposite sex it is vestigineous

ExampleVertiginous Male breast can be better explained tools of intelligent design than Darwin evolution now look at male nipple which are functional in female. Male & female have come much before mammals, so presence of male nipple in mammals can be explained by theory of tools of intelligent design better than Darwin evolution.

Midwest fp said: is there a "missing link?" in other words, any analogous useful organ in other animals to suggest what the appendix might have evolved from? An archaeopteryx-appendix analog, somehow. I'm no comparative biologist but it'd be fun to look for if I were.

Um, yeah, it's called a "caecum" and it's functionally a fermentation chamber for cellulose. Mostly found in obligate herbivores.

In fact, Darwin already proposed a scenario for the evolution of camera eyes that basically still holds today.

Incidentally, our eyes do not correct for chromatic aberration, except in the crude sense that only 4 % of the cones are receptors for blue.

====================

As far as I know, all vertebrates have an appendix. Sometimes it's enlarged, has an important function in digesting plant matter (or rather in housing bacteria that do the digesting), and is then called a caecum.

All "why" questions have already been answered. Here is the answer to all of them: "Everything is the way it is because it got that way" (I forgot the author; he's a development biologist).

This turns all "why" questions into "how" or even "what" questions: How did everything get the way it is? What regularities, what laws did this process follow? What are the causes?

On the other hand, you assert that "[r]eligion asks". Stop right there. Religion doesn't ask questions, it asserts answers without ever testing them. It never asks the fundamental question of science: "If I were wrong, how would I know?"

Just stumbled upon this blog. Though you do come across as a very intelligent (and cocky) surgeon, I find it humorous that you were wrong - very wrong. I don't have time to cite the many recent medical journals explaining how incredibly vital the appendix is to human survival. It houses many different white blood cells that seem to exchange information regarding infection and disease. It also stores healthy bacteria and then mobilizes this bacteria when needed. Such a great little organ. The reason it becomes infected is because we are too clean. Also disinfecting things, never exercising, cramming processed foods (sugars, preservatives, GMOs, etc.) down our throats has completely devastated our immune system. Because we're so clean, our dying immune system exercises even less, and thus, the little appendix becomes bloated and dies since it never has to do anything.

About Me

I'm a mostly retired general surgeon. With my surgical blog, my intention is to inform, entertain, and possibly educate the reader about surgery, and about the life and loves of a surgeon: this one, anyway. Don't know what I'm thinking, doing a political blog, too.
In an amazing coincidence, I've also written a book, "Cutting Remarks; Insights and Recollections of a Surgeon." It's about my surgical training in San Francisco in the 1970s, aimed at the lay reader with the goal of entertaining with good stories, informing with understandable details of surgical anatomy, procedures, and diseases. Knowing you, I bet you'd enjoy it. In fact, if you like Surgeonsblog, you'll absolutely love the book!

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.